3 monthsprior to your 65th birthday or terminating employment at age 65 or older

Contact Social Security Administration (SSA) to enroll in Medicare Part A and Part B if you or any dependents you wish to cover are entitled to Medicare, due to either age or disability. Make sure you understand the Initial Enrollment Period (IEP) and Special Enrollment Period (SEP) for Medicare and how these timelines affect the start date of Medicare.

A copy of your Medicare ID card showing enrollment in Medicare Part A and Part B (if entitled). Write your full name and the last four digits of your Social Security number on the copy of your card. If you wish to enroll dependents who are entitled to Medicare, include a copy of their Medicare ID card.

Payment for your first month’s health coverage premium (if not using pension deduction). You may want to keep a copy of your forms for your files.

PEBB must receive the form no later than 60 days after employer-paid coverage, COBRA coverage or continuation coverage ends. If enrolling in a Medicare plan, PEBB should receive the forms prior to the month the retiree coverage begins.

Send your Retiree Coverage Election Form (form A) to PEBB. The form must be received by PEBB no later than 60 days after your employer-paid coverage, COBRA coverage or continuation coverage ends. You may want to keep a copy of your form for your files.